ADHD Over Diagnosed?

The Canadian Medical Association Journal has scheduled a publication for an upcoming edition entitled: Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children.” As other studies that I have pointed out have shown, there is a problem with the diagnosis of young children with ADHD. There is what is called a “relative age effect.” That is, we have more children (as a percentage to the overall population) diagnosed with ADHD at lower, younger ages. This is measured within each grade, in other words, younger boys or girls in grade k-1-2-3 etc are more likely to be diagnosed with ADHD than are older boys or girls in the same grade. So if your child is born in November or December, the cut off ages for school entry in British Columbia, you are much more likely to end up with a diagnosis of ADHD. So what looks like ADHD, everyone assumes, may really be nothing more than a reflection of a younger age within the classroom. This is usually, some feel, the result of gathering too much information from one source, the school, where the child’s behaviour is not measured against his or her age group, but against his or her class. It’s really an unavoidable problem, but not one that we cannot correct for.
Boys born in December were 30% more likely to receive a diagnosis than those born in January (the oldest boys in the class). These boys were also 41% more likely to get medication than the older boys. As medication can have harmful affects on sleep, appetite and other issues, this should be of concern. What also should be of concern is that teachers making these reports that doctors rely upon to make a diagnosis (usually using a simple procedure called the SNAP-IV) don’t seem to be aware of these normal developmental differences within the class, and seem to fail to program for these with appropriate environmental supports for children with significantly different behaviour patterns based upon natural growth and maturation.
This study seems like a repeat of several completed in the past few years in the United States, and researchers might be using their time and our research money finding ways to compensate for these factors, but that’s my personal complaint about basic research that is often repeated many times for the sake of publication.

What can you do to make sure your child is not misdiagnosed?
First, remember that a younger child, especially in a younger grade, will act in ways that might appear to be reflective of ADHD. You need more than a simple diagnosis based upon a five minute observation and a couple of SNAP-IV forms. Medical doctors often do not have time to spend watching, playing, observing and interviewing as is necessary. You also need some basic data, like the SNAP-IV, but a key to the ADHD diagnosis is ruling out other causes for the behaviours of concern. That means ruling out anxiety, stress, panic, depression, mood disorders and…yes, normal developmental issues. I suggest you schedule an appointment and see a psychologist who is familiar with ADHD, children and classrooms. Being familiar with classroom expectations is critical, as often times misbehaviour is the result of environmental factors.
Most medical and psychological associations, groups and individual practitioners recommend a trail of behavioural therapy and environmental supports to attempt to deal with the behaviours of concern before medication is tried. Several of my recent posts have gone over these guidelines by the leading paediatric organizations. So, you need someone familiar with classroom environments, curriculum and teaching techniques to work with you.
Finally, nearly 50% of all children with ADHD have a comorbid disorder. That is, they have ADHD AND something else. That might include depression, anxiety, stress or any one of multiple learning disorders. If these comorbid disorders are dealt with properly the ADHD symptoms may be significantly reduced. So assessments for these problems should be part of any assessment and intervention for ADHD. Ask your school district of psychologist to conduct a psychoeducational assessment. A psychoeducational assessment will provide the data we need to develop a targeted intervention plan.

For more information on psychoeducational assessments please see my testing page at:

finally, my ADHD pages have a good deal of information to help you understand the assessment process. Assessment for ADHD, and Psychoeducational Assessments are fully explained.